In this first eFeature for 2017, Robbie looks at how the current transformation agenda is beginning to impact on sexual health services with the introduction of integrated tariffs and the development of e-services with ‘digital front doors’ in many parts of the country.
Robbie Currie is Sexual Health Programme Lead for the London Borough of Bexley. He is currently seconded to the ADPH London as the Strategic Lead for Sexual Health and is also Chair of the English HIV and Sexual Health Commissioners Group. In this first eFeature for 2017, Robbie looks at how the current transformation agenda is beginning to impact on sexual health services with the introduction of integrated tariffs and the development of e-services with ‘digital front doors’ in many parts of the country. He acknowledges however that further transformational work will need to be inventive to maintain high quality services when set against the backdrop of further funding reductions and proposed major changes to public health funding mechanisms.
The start of a new year is always the perfect time to take stock of the year just gone, to look at the here-and-now as well as make plans for the future. It is also a time when we tend to set personal and professional transformational goals, whether this involves training to run a marathon to improve fitness or picking up the phone more to reduce emails clogging up our inboxes!
The Oxford English dictionary describes transformation as ‘a marked change in form, nature, or appearance’ - whether personal or professional. In the work arena, this definition certainly covers the transformational plans for sexual health services that are being carried out across the country. Arguably the most important of these changes is the advent of online home-sampling services which will promote both self-efficacy and self-reliance. Prominent promotion of these services on sexual and reproductive health (SRH) websites will not only encourage take-up of the service itself, but will also persuade more users to ‘go digital’ for a wide range of sexual and reproductive health services.
In Bexley, our transformation plans continue apace: positive outcomes include the fact that more GP practices are providing sexual health services to residents, the home-sampling online service (first introduced in the summer of 2015) is seeing steady and consistent growth month-on-month and our participation in the London Sexual Health Transformation Programme (LSHTP) - in particular, the imminent introduction of the London Integrated Sexual Health Tariff (ISHT) - means that we’ll have greater granularity on activity from our providers which should enable us to commission services better for the future.
London’s sexual health services are also being transformed. 2017 will be the year when much of the hard work undertaken over the last few years will come to fruition - both through the awarding of new contracts and/or through the re-negotiation of existing ones. The introduction of the London ISHT will enable local authorities, sub-regions and London as a whole to have a much greater understanding of GUM/CASH activity and hopefully we will also see spend contained as we move to the new system. However, the transformation of London services is greater than just the introduction of the ISHT and you can click here for more information on the full extent of the plans contained in the LSHTP.
Similar positive transformations have already taken place in many areas of the country. Several local authorities have already introduced an integrated tariff, e-services with a ‘digital front door’ and increased capacity in primary care (especially in pharmacy provision).
They say that ‘austerity is the mother of invention’ and it has certainly been one of the driving forces behind our transformation programmes. All professionals working in the sexual health sector have already had to work extremely hard to maintain high quality and standards for service users. This year will show whether our transformational plans work; if not, we’ll have to be inventive in finding new solutions.
Over the next few years, public health will continue to face financial austerity with many further budgetary reductions planned. Local authorities are already planning for the loss of the Public Health ring-fence, annual reductions in the public health grant and the new Business Rate Retention (BRR) funding mechanism. The latter is set to radically change current funding arrangements. All the above will have an impact on providers who have already seen their budgets substantially reduced. NHS England and Public Health England (PHE) are not immune and are also likely to face budget reductions.
Looking forward to the coming year, I believe contraception could prove to be a key issue. Recently released contraception data suggests worrying trends. In some areas, women are experiencing greatly reduced accessibility to the full range of contraception methods. Although it’s a very mixed picture across the country and there is wide variation, I believe that this is counter-productive. In Bexley, we are addressing this issue by training up an additional 12 professionals. By augmenting existing services and increasing accessibility rather than reducing it, we hope to have a significant impact on women’s health and well-being overall.
On a positive note, some London GUM services have recently reported significant decreases in new HIV infections. This is almost certainly linked to privately purchased PrEP, and bodes well for the PHE/NHS England large scale trial of PrEP which aims to reach 10,000 people. Hopefully we will see this trend embed and continue to demonstrate positive outcomes. I’ve spoken with many colleagues across the country and they are reporting similar reductions in new HIV infections, at least anecdotally. Again, this gives cause for optimism.
However, despite great challenges ahead, we do still have money to spend and I personally work with extraordinarily committed people who are hell-bent on making things work and doggedly determined to provide users with the highest quality services possible.
The English HIV and Sexual Health Commissioners Group (EHSHCG) will continue to work to ensure the experience of sexual health, reproductive health and HIV commissioners is influencing the commissioning landscape and to support those responsible for improving sexual health and HIV in their local areas. EHSHCG has recently restructured (after the sad departure of my wonderful Co-Chair Jackie Routledge) and we welcome the appointment of Jon Dunn and Angie Blackmore as new Deputy Co-Chairs and look forward to appointing new regional representatives who will manage an increasing workload across the country.
I am certain that the same determination and commitment persists in teams across the whole sexual health sector, which will help ensure that the transformational work already undertaken or coming to fruition this year will reap rewards. I am also sure we will continue to work together collaboratively and constructively, continue to be inventive and innovative and continue to carry out transformational processes that will ensure we are helping people across England have the ‘best sex with the least harm’.
The content of all eFeatures represents the views and opinions of the authors. FSRH does not necessarily share or endorse the views expressed within them.